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MIDWIFERY IN CANADA, THE MESS WE’RE IN

Many people are confused about why Canadian birth attendants are prosecuted for the most minor actions. . . . calling herself a “midwife”, doing a vaginal examination at a woman’s request or with permission, advising a woman about how to eat for her unborn baby, etc.

Let me tell you how we got into the mess we’re in. Yes, it is a mess. Hundreds of thousands of dollars spent on legal actions, clients left upset and confused, hospital workers unclear about the legalities in their area, each province of Canada having a different wording in their Act, midwives mistrusting doulas and each other. It’s a climate of fear and turmoil that isn’t getting better after more than 20 years of legislating midwifery. (Ontario regulated in 1993, B.C. followed in 1998)

The first problem is that legislators tried to make laws to cover a life event that is natural and one that a woman can do all by herself, if she chooses. Birth is a normal life process. We don’t usually legislate who can be with an adult when they are in their own home. What can you make illegal about a woman having a baby and choosing someone to be with her? Well, you can make it illegal for that someone to charge money for being there. That doesn’t really fit with a concern for the well-being of the woman/baby. If a birth attendant is really wealthy can they go to help birthing women with no fear of the law? If the pregnant woman wants to donate money to her helper’s children, is that illegal? You can see it gets very tangled. The laws have been twisted and turned to try to make them less ridiculous as time goes by but no province has succeeded in coming up with wording that makes common sense.

Then, the law makers thought, “okay let’s make it illegal to do clinical acts like vaginal exams, injections, blood tests, etc.” Trouble with that is a) it is almost impossible to police these activities when they happen in a private home and, b) women allow their partners to perform vaginal exams all the time. Many massage therapists do pelvic therapy with vaginal exams, naturopaths, nurses, etc. so how does it help to say that one particular group cannot do vaginal exams? So, by saying that only a member of a midwifery disciplinary body may do a pelvic exam, things get almost laughable. Since any 16 year old boy can figure out how to do it, it’s hardly an act that needs 4 years of training. Many lay people have to give injections to their children/loved ones, learning how to draw blood takes about 2 hours, all these things are done by a myriad of workers in the community. It is grasping at straws to make these minor clinical acts a basis for a prosecution.

The original intention of seeking licensure started with midwives wanting to be paid under the National Medical insurance plan and to be protected from prosecution/persecution from the giant medical monopoly. That intent backfired right away due to the medical profession. Instead of embracing the midwives as colleagues, they began advising the clients of registered midwives to sue their midwife. There have been lawsuits against registered midwives here in B.C. where millions of dollars have been paid out to families. If a child has any type of neurological damage, the family physician advises the parents that “ the money won’t come out of your midwife’s pocket. That’s why they carry insurance. The insurance is there and you don’t know if your child will need special care that’s not covered by the National Medical insurance plan when he/she gets older. You’d better sue now.” Of course, they would never say that if the care provider was a physician. You can guess what happened then. The insurance rates for midwives right across the country went through the roof. Different provinces have different schemes for covering the midwives but the bottom line is that the government really doesn’t want more midwives because each midwife has to be subsidized for about $30,000 per year in order to provide insurance for her practice. If the midwives had to pay it all, they would be out of business immediately. The government also doesn’t want to give them a raise which leads to a great deal of bitterness on the part of the registered midwives.

Registered midwives are between a rock and a hard spot. They want to follow their dream and have happy, contented clients BUT they rely on the physicians to give them hospital privileges and, if they don’t toe the line of what the doctors wish them to do, they can lose those privileges or even lose their registration.

So, when you’re wondering what’s going on with registered-midwife-generated court cases to pound unregistered birth attendants out of business in Canada, this is some of the background. Because the numbers of registered midwives is low AND the midwives are so limited by the medical profession, there exists an alternative birth attendant market. There are a number of women throughout the country who still go out to help at home births without a blessing from the medical profession/government. They simply don’t want to work in that space between the rock and the hard spot.

3 thoughts on “MIDWIFERY IN CANADA, THE MESS WE’RE IN”

I just chose to ‘free birth’ my 2nd child 2 months ago. In Saskatoon the chances of getting a midwife was 50-50 or some months even 60% chance of being rejected. Leaving me and others wanting a peaceful home birth no choice to do it alone or to hire an unlicensed birth attendant. Our system IS a huge mess and needs change! I personally know doulas that have faced legal action for providing the services a mother requested and because it overlaps with the duties in the midwifery Act and then she’s prosecuted as practicing midwifery. Such bull shit.

“The original intention of seeking licensure started with midwives wanting to be paid under the National Medical insurance plan and to be protected from prosecution/persecution from the giant medical monopoly.”

Well, that seems to have all worked out wonderfully! (Sarcasm)… As a student midwife in Canada (not through the Canadian university system but rather through a private/independent school in the U.S.) I can attest to how frustrating and virtually impossible the path of pursuing midwifery has become in this country. Compared to the midwives who came about in the 70’s and 80’s prior to the adoption of regulation and licensure there are far fewer opportunities for obtaining education and experience for young midwives now. It saddens me that the former generation of Canadian midwives were complicit in creating this awful system that affords this generation far less freedom and opportunity in becoming midwives than they had themselves. Because regulated midwifery is so high-cost it creates a very tenuous situation where RM’s feel that no one should be able to practice midwifery apart from being indebted and ideologically beholden to the state for their entire working lives… Thus RM’s become the government’s gatekeepers enabling the persecution of anyone operating out of their highly contrived, flawed, inadequate system. What we have is an absurdly exclusive and impractical system so far removed from what our Canadian foremothers were able to enjoy, so far removed from our communities and heritage… Heartbreaking that the midwives themselves signed on the dotted line to make it so. The government has no business telling women what they can do and who they can invite into their bedrooms. It is legal to have a home birth and by virtue of that all choices related to this private, intimate, reproductive event should belong to the mother. It is a parent’s rights issue, not a midwife’s rights issue, as Carla Hartley has said. Thank you Gloria for being the exception and standing out as a woman of integrity, it’s traditional birth attendants in Canada like you who inspire me to press forward despite all adversity. You are precious, like drops of water in the desert.